[Shock during leptospirosis icterohaemorrhagica. Four cases (author's transl)].

Four patients with leptospirosis icterohaemorrhagica (LH) were admitted to an intensive care unit in a state of shock. Haemodynamic studies showed that the shock was due to three different mechanisms which were often associated or successive in the same patient: (1) septic shock with fall of systemic vascular resistance (SVR) and no widening of arteriovenous oxygen difference (AVDO2); (2) cardiogenic shock, probably due in part to specific myocarditis, with reduced left ventricular work and normal or high pulmonary wedge pressure; and (3) hypovolaemic shock with the increased SVR and widened AVDO2. These data suggest that haemodynamic studies are required in patients with LIH associated with shock in order to determine its mechanism and provide guidelines for its treatment.